TOOL: Sample Exit Interview Form

POSTED: March 2012

[Insert your organization’s name here]

EXIT INTERVIEW FORM

CONFIDENTIAL

Your contributions to [insert your organization’s name here] during your period of employment are greatly valued. Before you leave the organization, we would appreciate it if you could share some of your thoughts and insights with us. The purpose of this form is to help us to learn some of the good and not-so-good experiences you have had with ______. This information will be used to improve the organization and will be kept strictly anonymous and confidential. Thank you for being open and sharing your thoughts with us.

EXIT INTERVIEW FORM

DATE: ______

NAME (OPTIONAL): ______

POSITION: ______

LENGTH OF EMPLOYMENT WITH ______: ______

REASON FOR LEAVING:

Relocation

Better Opportunity

Better compensation/salary/benefits

Lack of Advancement

Lack of Training and Development

Management Related

Working conditions

Job Dissatisfaction

Job Related Stress

Corporate Culture

Lack of recognition

Other


Comments

Your Role at ______

1.  How did you feel about your most recent role at ______?

a)  What did you like most about your role

b)  What did you like least about your role

Your Program

2. How did you feel about the working environment in your program?

How would you describe the moral?

3. How satisfied were you with the following:

a)  The communication of goals and direction of the program

a)  Recognition for successful initiatives

b)  Performance Feedback

4. a) How satisfied were you with the training the agency provided you for your current job?

b) How satisfied were you with the career options and career development available for you at ______?

Compensation

5.  Do you believe that your compensation package was adequate as compared to the market?

6.  Were you satisfied with the benefit package?

The Agency

7.  How did you feel about working for ______?

8.  What are some of the Agency’s strengths?

9.  What are some areas that we can improve on?

10. Would you recommend a ______to other candidates?

11. If there is anything that ______could have done to encourage you to change your mind about resigning what would it be?


OTHER COMMENTS:

ITEMS TO BE RETURNED:

Keys ____

Alarm System Card ____

Collective Agreement ____

Computer Pass Word ____

Phone Password ____

Andrew Fleck Child Care Services agreed to share this document as a resource for the CCHRSC’s HR Toolkit. Resources are provided for reference only. Always consult current legislation in your jurisdiction to create policies and procedures that meet the needs of your organization.

CHILD CARE HUMAN RESOURCES SECTOR COUNCIL WWW.CCSC-CSSGE.CA 4